Evidence map›Paper›PMID 39237982›Full record

Trial reportBMC health services research2024

Application of the behaviour-centred design to understand facilitators and deterrents of hand hygiene among healthcare providers: findings from a formative phase of a cluster randomised trial in the Kampala Metropolitan area.

Tonny Ssekamatte, Richard K Mugambe, John Bosco Isunju, Rhoda K Wanyenze, Aisha Nalugya, Christine Adyedo, Solomon T Wafula, Esther Buregyeya, Rebecca Nuwematsiko, Joann Bateman and 4 more

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Tonny SsekamatteDepartment of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. tssekamatte@musph.ac.ug.
Richard K MugambeDepartment of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
John Bosco IsunjuDepartment of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
Rhoda K WanyenzeDepartment of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
Aisha NalugyaDepartment of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
Christine AdyedoMukono District Local government, P.o Box 110, Mukono, Uganda.
Solomon T WafulaDepartment of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
Esther BuregyeyaDepartment of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
Rebecca NuwematsikoDepartment of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
Joann BatemanSchool of Health and Related Research, The University of Sheffield, Sheffield, UK.
Julie BalenSchool of Health and Related Research, The University of Sheffield, Sheffield, UK.
Lynnette LusenakaNational Academy of Sciences, Programs Office, Building 2101 Constitution Avenue, Washington, DC, USA.
Habib YakubuThe Centre for Global Safe Water, Sanitation and Hygiene, Hubert Department of Public Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.
Christine L MoeThe Centre for Global Safe Water, Sanitation and Hygiene, Hubert Department of Public Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.

Funding

National Academies of Science (NAS) and the United States Agency for International Development (USAID) Award Number AID-OAA-A-11-00012
6 · The paper itself

Abstract

backgroundHand hygiene is known to reduce healthcare-associated infections. However, it remains suboptimal among healthcare providers. In this study, we used the Behaviour-centered Design approach to explore the facilitators and deterrents to hand hygiene among healthcare providers in the Kampala Metropolitan area, Uganda.

methodsWe conducted a formative qualitative study as part of a cluster randomised trial in 19 healthcare facilities (HCFs). The study used 19 semi-structured and 18 key informant interviews to collect data on hand hygiene status and facilitators and deterrents of hand hygiene. Research assistants transcribed verbatim and used a thematic framework aided by Nvivo 14.0. to undertake analysis. We used thick descriptions and illustrative quotes to enhance the credibility and trustworthiness of our findings.

resultsAbout 47.4% of the HCFs had sufficient hand hygiene infrastructure, and 57.9% did not report total compliance with hand hygiene during patient care. The physical facilitator for hand hygiene was the presence of constant reminders such as nudges, while the biological included the frequency of patient contact and the nature of clinical work. The only biological deterrent was the heavy workload in HCFs. The executive brain facilitators included knowledge of workplace health risks, infection prevention and control (IPC) guidelines, and a positive attitude. A negative attitude was the executive brain deterrent to hand hygiene. Recognition, rewards, and fear of infections were the only motivated brain facilitators. Behavioural setting facilitators included proximity to functional hand hygiene infrastructure, the existence of active IPC committees, good leadership, and the availability of a budget for hand hygiene supplies. Behavioural setting deterrents included the non-functionality and non-proximity to hand hygiene infrastructure and inadequate supplies.

conclusionsThe study revealed low compliance with hand hygiene during the critical moments of patient care and inadequacy of hand hygiene infrastructure. The deterrents to hand hygiene included a heavy workload, negative attitude, inadequate supplies, non-functionality, and long distance to hand washing stations. Facilitators included constant reminders, fear of infections, frequency of patient contact and nature of clinical work, positive attitude, knowledge of IPC guidelines, recognition and reward, good leadership, availability of budgets for hand hygiene supplies, availability and proximity to hand hygiene supplies and infrastructure and active IPC committees.

trial registrationISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020.

Indexed as

Guideline AdherenceHand HygieneHealth PersonnelQualitative ResearchAdultAttitude of Health PersonnelCross InfectionFemaleHumansInterviews as TopicMaleUgandaAnd ControlBehaviour centered designHand hygieneInfection PreventionUganda

Identifiers

PMID39237982
PMCPMC11378471

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.